| NPI | 1972319499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER BLACK-COYNE Executive Director 800-939-6636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2024-12-09 |
| Last Update Date | 2025-07-15 |