| NPI | 1710672019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY MARIE NIEMAN Dir Of Credentialing & Enrollment 513-834-7063 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine |
| Additional Taxonomies | 261QM2800X Clinic/Center, Methadone Clinic |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2023-04-11 |
| Last Update Date | 2023-04-11 |