| NPI | 1720738529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY CHANEL' LONG Owner 430-280-9381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2022-03-24 |