| NPI | 1750779500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY MARIE NIEMAN Director 833-510-4357 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine Addiction Medicine |
| Additional Taxonomies | 261QM2800X Clinic/Center Methadone |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2015-01-02 |
| Last Update Date | 2024-05-06 |