| NPI | 1033007646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NAPHASORN REYES Owner 641-426-3956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2025-06-24 |
| Last Update Date | 2025-06-24 |