NPI | 1649775123 |
---|---|
Entity Type | Organization |
Authorized Contact | MARK STOVALL Facility CEO 662-281-9992 |
Organization Subpart ? | No |
Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MS OOC-AGENCY) |
Enumeration Date | 2018-03-27 |
Last Update Date | 2021-09-24 |