| NPI | 1467254565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY HARRISON MILLER Owner 386-986-6498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2025-03-27 |
| Last Update Date | 2025-03-27 |