| NPI | 1982269601 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY D PHILLIPS Revenue Cycle Department Manager 618-937-6483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 261QM2800X Clinic/Center, Methadone Clinic | |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2019-05-08 |