| NPI | 1942920459 |
|---|---|
| Doing Business As | PROVIDENCE TREATMENT |
| Entity Type | Organization |
| Authorized Contact | DUNG GABE LAU COO 617-314-7544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2022-09-02 |