| Name | Value |
|---|---|
| PROVIDER TYPE | Ambulatory Health Care Facilities |
| CLASSIFICATION | Clinic/Center |
| DEFINITION | An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. |
| AREA OF SPECIALIZATION | Methadone |
| STATUS | Active |
| X12 CODE | 261QM2800X |
| INDIVIDUAL/NON | NON-INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5252207 |
| EFFECTIVE DATE/TIME |
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