| NPI | 1659797280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATASHA GREEN RN 1718-994-4901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: NY 952550787) |
| Enumeration Date | 2014-03-06 |
| Last Update Date | 2014-03-06 |