| NPI | 1851171219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD THATCHER CFO 754-217-8127 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-10-03 |
| Last Update Date | 2023-10-03 |