| NPI | 1003885146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA K DANIELS Program Billing Specialist 386-842-5501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2020-08-22 |