| NPI | 1902797376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE COSTLEY Licensing Specialist 443-548-3733 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 276400000X Rehabilitation, Substance Use Disorder Unit |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2025-07-14 |