| NPI | 1861366536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE WILKS Owner 844-945-5772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 251S00000X Community/Behavioral Health | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 347C00000X Private Vehicle | |
| 385H00000X Respite Care | |
| Enumeration Date | 2025-10-03 |
| Last Update Date | 2025-10-03 |