| NPI | 1669837449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BELINA SURUJON Licensing & Contracting Director 754-300-3120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2015-12-22 |
| Last Update Date | 2022-06-01 |