| NPI | 1578389912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TECKY ANN RUSK Owner 567-429-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2024-12-02 |
| Last Update Date | 2024-12-02 |