| NPI | 1972217503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA BOOKOUT Owner 580-308-0067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2024-09-26 |