NPI | 1013986082 |
---|---|
Doing Business As | NB - LAKE RESIDENTIAL SUPPORT CSN |
Entity Type | Organization |
Authorized Contact | TONYA MARIE FASONE Fiscal Manager 614-466-9930 |
Organization Subpart ? | No |
Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
Enumeration Date | 2006-03-14 |
Last Update Date | 2011-11-30 |