| NPI | 1962394502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIE EWALD Contract And Compliance Specialist 937-414-1948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2025-07-17 |
| Last Update Date | 2025-07-17 |