| NPI | 1700134046 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH CARL RUSS Medical Director 760-416-7755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: CA MFC49984) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2014-07-02 |