| NPI | 1518668235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID SLATTERY Manager 877-215-2224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-03-10 |
| Last Update Date | 2023-03-10 |