| NPI | 1568815454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DYLAN WALKER Owner 253-653-2243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: CA 201605310246) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: CA 201605310246) |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2019-07-11 |