| NPI | 1801431069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WARREN PHILLIPS Owner 314-603-3492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2021-07-31 |