| NPI | 1851936363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN JAVIS Chief Executive Officer 929-603-6858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-11-08 |
| Last Update Date | 2019-11-08 |