| NPI | 1497102867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMIEL CHICHEPORTICHE Program Sponsor 410-415-6384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: MD 906136) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MD 906136) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2016-08-18 |