| NPI | 1598681488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORETTA ANN BOSTIC Clinical Director 304-208-0707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2026-06-25 |
| Last Update Date | 2026-06-25 |