| NPI | 1457053787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TENNILLE HARRIS Executive Director 877-290-0201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2023-03-20 |