| NPI | 1043931090 |
|---|---|
| Doing Business As | NOT APPLICABLE |
| Entity Type | Organization |
| Authorized Contact | BRUCE BOEHM President 712-210-6296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2022-09-08 |