| NPI | 1538550231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE MORA Secretary 855-806-9448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2015-02-17 |