| NPI | 1972959344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEMECE MICHELLE GASAWAY Director Of Licensing 214-365-6126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: SC OTPN-0171) |
| Additional Taxonomies | 261QM0801X (Licence: SC OTPN-0171) |
| 261QM2800X Clinic/Center, Methadone Clinic (Licence: SC OTPN-0171) | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2019-02-21 |