| NPI | 1861110090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE WATERMAN Clinical Director 443-707-5558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2022-08-15 |