| NPI | 1639996374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY FERGUSON Owner 330-907-4391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2024-09-24 |