| 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 |