| NPI | 1538902168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER PENROD Authorized Rep 305-900-4715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 251S00000X |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2024-06-12 |
| Last Update Date | 2024-06-13 |