| NPI | 1508462128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER DORVAL Provider 401-626-0169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2020-12-09 |