| NPI | 1972350627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAYWARD I CAROLIN-SALAZAR VP O 260-205-2516 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-05-01 |
| Last Update Date | 2024-05-01 |