| NPI | 1942914288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SASHA D CLAYBORNE Owner / CEO 419-360-9577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2024-07-31 |