| NPI | 1659982437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY WEST Drector 291-935-4251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2020-08-13 |