| NPI | 1659603512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA PORTER Credentialing Coordinator 660-890-8126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2010-02-03 |