| NPI | 1497414718 |
|---|---|
| Former Legal Business Name | PH WELLNESS |
| Other Name | PH WELLNESS |
| Entity Type | Organization |
| Authorized Contact | ANGELA N MCMAHON Program Director 161-987-1734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2021-12-14 |