| NPI | 1013797364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKLYN TYLER PAUL Owner 682-227-0600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 251S00000X |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2024-02-21 |