| NPI | 1023317187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY GREEN Administrator 817-510-7741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2013-08-21 |