| NPI | 1568114262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW NELSON Owner 304-551-1266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QR0800X Clinic/Center, Recovery Care |
| Enumeration Date | 2022-01-24 |
| Last Update Date | 2022-03-23 |