| NPI | 1477300465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRILL VESSELOV President 812-606-2216 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2025-02-14 |