| NPI | 1528501772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUPERT J. MCCORMAC President 800-805-6989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2022-06-07 |