| NPI | 1902619729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN FARRELL Owner 580-507-2911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2025-12-01 |