| NPI | 1861078784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRYNA SANDERS President 419-378-9212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2021-12-17 |