| NPI | 1982953022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD LEON CLOUD D.O. 678-598-0651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 347B00000X Bus |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2012-09-05 |