| NPI | 1598159378 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS G INGRAM Owner 800-545-9031 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2015-03-19 |