| NPI | 1992927537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN DENISE PRUITT Substance Abuse Counselor 276-963-3554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: VA LVN-164X00000X) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |