| NPI | 1972331932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUALINE RENETTE PETERSON CEO 410-202-0883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2024-07-22 |