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 Clinic |
261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
324500000X Substance Abuse Rehabilitation Facility | |
Enumeration Date | 2015-01-02 |
Last Update Date | 2024-05-06 |