| NPI | 1083101216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY J MCDONALD Billing Supervisor 228-863-1132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MS M8723) |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2018-04-13 |