| NPI | 1962163782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY MARIE NIEMAN Director 833-510-4357 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine |
| Additional Taxonomies | 251S00000X |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2024-09-18 |