| NPI | 1891176475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID FARACHE Owner 772-888-3025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: FL 4301) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: FL 4301) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2022-07-21 |