| NPI | 1538737291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDRA KORORTKEVICH Exec 855-460-0139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2021-09-09 |