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 | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
Enumeration Date | 2022-01-04 |
Last Update Date | 2023-10-16 |