| NPI | 1790489706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA RENEE STAMP Billing Director 800-545-9031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2023-03-27 |