| NPI | 1669940870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ANDREW WELTY Executive Director 234-801-2469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2018-11-06 |
| Last Update Date | 2018-11-06 |