| NPI | 1699481499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW KELLICKER Owner 774-249-8994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-01-25 |
| Last Update Date | 2023-01-25 |