| NPI | 1518996354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHONDA VICTOR Credentialing Coordinator 774-628-1033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital (Licence: MA 1008) |
| Additional Taxonomies | 101Y00000X Counselor |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2022-07-21 |