| NPI | 1770139719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL S RODMAN Credentialing Coordinator 330-439-8492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251V00000X Voluntary or Charitable |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2025-11-03 |