| NPI | 1952068843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE M SPELLIS-FREYRE Authorized Official 419-740-3022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2021-11-26 |
| Last Update Date | 2023-09-29 |