| NPI | 1053187914 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE SMITH Executive Director Ar & Reimb. 209-955-2364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 314000000X Skilled Nursing Facility | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2023-11-30 |