| NPI | 1922726736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD JUSTIN ETLING CEO 781-389-5579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2022-08-17 |
| Last Update Date | 2022-08-17 |