| NPI | 1629447313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELI KORNMILLER Credentialing Specialist 561-672-8345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: FL 5601) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2022-07-21 |