| NPI | 1821783374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JOHNSON Director/Manager 865-805-0567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QM0801X |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2024-02-28 |