| NPI | 1881084473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN LEDOUX Facility Coordinator 982-708-9615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WA 27125700) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2015-02-03 |