| NPI | 1750938130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY FRANK KOLACZKOWSKI Owner 937-223-1781 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2024-08-15 |