| NPI | 1649098302 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUG PROCTOR Owner 772-946-1665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2024-10-01 |
| Last Update Date | 2024-10-04 |