| NPI | 1609428804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDRA FICKEN Sr. Rcm L Manager 855-408-1143 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2026-01-24 |