| NPI | 1629888235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVANTE MULLEN Executive Director 771-220-9224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2025-01-08 |
| Last Update Date | 2025-01-08 |