| NPI | 1992403547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN RYAN HETRICK CEO 772-353-1410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2023-02-22 |