| NPI | 1043417975 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA LEE KOONTZ Office Assistant 304-262-9600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: WV 320900000X) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2007-08-21 |