| NPI | 1760247993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATISHA A SHEPHERD Owner 909-898-7665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2024-02-16 |
| Last Update Date | 2024-02-16 |