| NPI | 1891125563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE EASTHAM Clinical Director 817-300-1590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: TX 3687-3688) |
| Enumeration Date | 2013-11-17 |
| Last Update Date | 2013-11-17 |