| NPI | 1689454266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREA CHARLISE MITTER BUGG Director 443-226-3906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2024-03-12 |