| NPI | 1588102438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUPERT JAMES MCCORMAC President 800-805-6989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QM2800X Clinic/Center Methadone | |
| 261QP2300X Clinic/Center Primary Care | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2024-02-06 |