| NPI | 1053686402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY LEFLER Occupational Therapy Assistant 980-521-3249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2012-03-19 |