| NPI | 1992417661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH ANTHONY VUKASINOVICH CEO 937-369-3020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| Enumeration Date | 2022-12-14 |
| Last Update Date | 2022-12-14 |