| NPI | 1467158543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY CLUETT Billing 508-209-7089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2023-02-01 |
| Last Update Date | 2025-09-30 |