| NPI | 1013219716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNE THOMAS Medicaid Billing Specialist 386-842-5555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2010-12-01 |