| NPI | 1962037010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NINA ROY Administrator 270-585-4306 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2025-02-20 |