| NPI | 1720784572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY DAVIS Revenue Cycle Manager 872-235-0258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2023-02-03 |
| Last Update Date | 2023-02-03 |