| NPI | 1669155362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL BRENNAN Billing Director 385-529-8735 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2023-08-09 |