| NPI | 1699551754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER SISCO Owner 606-367-3980 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2023-09-05 |
| Last Update Date | 2024-03-23 |