| NPI | 1609689033 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIE EWALD Administrator 937-414-1948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2025-01-29 |
| Last Update Date | 2025-01-29 |