| NPI | 1912310947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDDY LAI Controller 424-290-3341 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 251S00000X | |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2020-08-20 |