| NPI | 1477801090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE FLORES Account Specialist 754-201-2265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: FL 1706AD975201) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2012-08-29 |