| NPI | 1659746469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOPE STEIN Owner 267-972-7494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: PA 467133) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2015-12-04 |
| Last Update Date | 2018-06-23 |