| NPI | 1578396305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA SIMMONS Board Member 606-343-0216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-08-26 |
| Last Update Date | 2025-01-24 |