| NPI | 1063002079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DICKSON IDUSUYI CEO 225-610-5376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2021-01-23 |
| Last Update Date | 2021-01-26 |