| NPI | 1740822667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GILBERT YATES Contract Manager 877-262-7803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2024-10-01 |