| NPI | 1477267680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENYA CONWAY Owner 443-398-1414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2023-01-11 |