| NPI | 1053951764 |
|---|---|
| Doing Business As | 3221 SOUTHLAND BLVD |
| Entity Type | Organization |
| Authorized Contact | ANNA TODD Corporate Office & Project 800-299-5161 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2022-04-27 |