| NPI | 1700245719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELI KORNMILLER Senior Credentialing Specialist 561-672-8345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: FL 1550AD332201) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2016-02-18 |