| NPI | 1659958718 |
|---|---|
| Other Name | TCOA 2301 |
| Entity Type | Organization |
| Authorized Contact | JENNIFER SLIS Rcm 772-248-4800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2024-12-02 |