| NPI | 1063050011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVORY WILSON Owner 225-283-1447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2019-12-19 |