| NPI | 1649044041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED TURNER Billing Manager 772-812-9652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2023-11-07 |
| Last Update Date | 2024-03-12 |