| NPI | 1053156166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA YVETTE JACKSON Surrogate 443-418-4254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2024-06-28 |
| Last Update Date | 2024-06-28 |