| NPI | 1508647918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE KSIDO CEO 747-250-4884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-10-11 |
| Last Update Date | 2023-10-11 |