| NPI | 1770463697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONA LISA PAULO Ms 702-802-5410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2025-09-03 |
| Last Update Date | 2025-09-03 |