| NPI | 1710579099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA EUGENE MARQUEZ CEO 877-414-3007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2023-10-16 |