| NPI | 1609381771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM NEVADOMSKI Owner 704-625-2828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: NC MHL-060-1367) |
| Additional Taxonomies | 251S00000X |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: NC MHL-060-1367) | |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2023-03-16 |