| NPI | 1477013696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY MILLER Clinical Director 386-986-6498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2022-05-18 |