| NPI | 1962298141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOSIA KING Owner 262-748-2596 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| 174200000X Meals | |
| 251S00000X Community/Behavioral Health | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2025-04-16 |
| Last Update Date | 2025-04-29 |