| NPI | 1558874461 |
|---|---|
| Doing Business As | FCCR SOUTHLAKE |
| Doing Business As | FCCR SOUTLAKE |
| Entity Type | Organization |
| Authorized Contact | ROBYN TANIS Exec Dir Contract Management 856-533-8762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 251S00000X |
| 261QR0800X Clinic/Center, Recovery Care | |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2023-11-21 |