| NPI | 1477937969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK DONNELLY CEO 352-347-6272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: FL 0542AD045901) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2015-07-14 |