| NPI | 1861967960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNWICK NATHAN Owner 860-938-6845 |
| Organization Subpart ? | No |
| Primary Taxonomy | 276400000X Rehabilitation, Substance Use Disorder Unit |
| Additional Taxonomies | 251S00000X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2018-10-04 |