| NPI | 1083972442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARIS L SILEGA President 862-241-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2012-04-24 |