| NPI | 1861885204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDI RENEE ROLF Office Secretary Iii 410-228-7714 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MD 904628) |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2015-03-10 |