| NPI | 1649996216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN P MEENAN Administrator 443-880-1164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2023-06-02 |