| NPI | 1861720260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA PORTER Credentialing Manager 660-890-8156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MO 866201403) |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2024-09-02 |