| NPI | 1497961759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA JACKSON CFO 407-351-7080 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: MN 831007-2-CDT) |
| 3336C0002X Pharmacy Clinic Pharmacy (Licence: MN 261484-7) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2022-11-04 |