| NPI | 1467124388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GILBERT YATES Contract Manager 877-262-7803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2024-12-19 |