| NPI | 1609112002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE FLORES Account Specialist 754-201-2265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: FL 1550AD931401) |
| Enumeration Date | 2012-12-13 |
| Last Update Date | 2012-12-13 |