| NPI | 1851050983 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMIEL CHICHEPORTICHE Program Sponsor 410-258-8939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Enumeration Date | 2021-12-16 |
| Last Update Date | 2023-03-09 |