| NPI | 1710767405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN M TAYLOR Revenue Cycle Credentialing Spec. 618-512-1803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2023-10-02 |