| NPI | 1578077509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY MARIE NIEMAN Director 833-510-4357 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2024-05-06 |