| NPI | 1700642428 |
|---|---|
| Doing Business As | CMS ELYRIA |
| Entity Type | Organization |
| Authorized Contact | ALEJANDRA VILCHIS Credentialing Provider Data Manager 480-977-1438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2024-02-21 |