| NPI | 1538932140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE COSTLEY Director Of Provider Enrollment 443-839-6928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2024-03-20 |