| NPI | 1881003101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANET G. MINOR Program Director 386-238-1348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: FL 0764ad071101) |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2014-08-12 |