| NPI | 1932691524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHONDA VICTOR Credentialing Coordinator 774-628-1033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2018-05-31 |