| NPI | 1891332193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH VERICKER Authorized Official 800-218-1734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2022-05-23 |