| NPI | 1548579121 |
|---|---|
| Former Legal Business Name | HENRY LEE WILLIS |
| Entity Type | Organization |
| Authorized Contact | LISA ANNE SANSOUCY Clinician 508-799-2934 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MA 6707) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2010-09-30 |