| NPI | 1598078735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IKE DWECK Director 866-569-7233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: NY 004253) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2010-07-16 |