| NPI | 1598017733 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBYN TANIS Executive Director Of Contract Mana 856-533-8762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC MHL-095-046) |
| 251S00000X Community/Behavioral Health (Licence: NC NC-10072-M) | |
| 261QR0800X Clinic/Center Recovery Care | |
| 332900000X Non-Pharmacy Dispensing Site (Licence: NC NC-10072-M) | |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2022-07-14 |