| NPI | 1700393972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM BRUGGEMAN Managing Member 833-210-4673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2020-09-01 |