| NPI | 1447996145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYIA GODLOCK Owner 410-617-8043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children |
| Enumeration Date | 2022-05-06 |
| Last Update Date | 2022-05-06 |