| NPI | 1922510080 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED ANDIA Owner 561-814-5455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2017-12-20 |