| NPI | 1972361681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREA CHARLISE MITTER BUGG Director 443-226-3906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2024-03-07 |
| Last Update Date | 2024-03-13 |