| NPI | 1093231722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BANNER-POFF Director 423-631-0336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: TN 14965) |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2017-08-15 |