| NPI | 1982576443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DREW C FULLER Owner 844-387-7469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2025-09-23 |
| Last Update Date | 2025-09-23 |