| NPI | 1861898934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY MARIE NIEMAN Director 338-510-4357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MA 1942434311) |
| 261QH0100X Clinic/Center, Health Services | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2024-03-14 |