| NPI | 1619661576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH DESIDERIO Mgr 424-478-1336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation |
| Additional Taxonomies | 177F00000X Lodging |
| 251S00000X | |
| 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 305R00000X Preferred Provider Organization | |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2023-06-16 |