| NPI | 1992786859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL CHARLES BORG Psychologist 315-772-8801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 276400000X Rehabilitation, Substance Use Disorder Unit (Licence: ID ICAADC 952) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2020-08-22 |