| NPI | 1861912305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON LARRICK Owner 917-402-2991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2017-06-26 |