| NPI | 1538931985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYRON MISSOURI Owner 443-854-1646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QC1500X Clinic/Center Community Health | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| 261QR0800X Clinic/Center Recovery Care | |
| 276400000X Rehabilitation, Substance Use Disorder Unit | |
| Enumeration Date | 2023-10-27 |
| Last Update Date | 2023-10-27 |