| NPI | 1457804114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY DORMAN President 209-575-1580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: CA 100095AP) |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2016-09-15 |