| NPI | 1689196578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARL MICHAEL PERTEET Consultant/Accountant 800-881-2740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM2800X Clinic/Center, Methadone Clinic |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2019-03-22 |