| NPI | 1760211197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONTAE AMOS Owner 337-292-0194 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2024-08-01 |
| Last Update Date | 2024-08-01 |