| NPI | 1790390169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARLA MOSES Credentialing Attorney 443-500-3202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-09-12 |
| Last Update Date | 2024-04-23 |