| NPI | 1538923016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KOTELYAN ANI Agent/Owner 747-477-4309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2024-06-06 |