| NPI | 1992112692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER REASON Director 754-300-4518 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: FL 1023710) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2018-06-19 |