| NPI | 1811483308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE L BEACH Director 772-341-4472 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0800X Clinic/Center, Recovery Care |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2018-07-08 |
| Last Update Date | 2019-01-19 |