| NPI | 1477882504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN PETCAVAGE Administrator 954-587-7771 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2009-12-21 |
| Last Update Date | 2010-09-29 |