| NPI | 1700756103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED TURNER Billing Manager 772-812-9652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2025-11-10 |
| Last Update Date | 2025-11-19 |