| NPI | 1972091999 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOWARD GOODMAN Clinical Director 866-236-0968 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2018-06-04 |