| NPI | 1063601565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTWAN LEON LEWEY Executive Director 904-537-0599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: FL 08077106) |
| Enumeration Date | 2007-10-20 |
| Last Update Date | 2007-10-20 |