| NPI | 1609588896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN FORNEY Co Owner 443-529-9083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2022-12-19 |