| NPI | 1457757833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND S TUCKER Collections Manager 945-234-2463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2016-11-22 |