| NPI | 1558752642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA RAAB Owner 239-362-0710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: FL 2036AD6563-01) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2020-01-16 |