| NPI | 1922377563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS FOWLKES Secretary/Treas 662-281-9992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2014-03-05 |