| NPI | 1699216903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY DOSS Program Administrator 501-314-9846 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: CA 300208DP) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2017-03-23 |