| NPI | 1043679384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LLOYD BLAKE Preparer 718-994-8460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: NY 300577) |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2016-02-15 |