| NPI | 1962958363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN WAYNE MILBY Authorized Official 270-689-0905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2024-06-13 |