| NPI | 1457012486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAILEN BAKER Owner 606-401-3185 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-01-03 |
| Last Update Date | 2024-07-31 |