| NPI | 1790806115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON HENDRICKS CEO 814-940-0407 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: PA 707235) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: PA 707235) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2024-04-10 |