| NPI | 1104096130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN E. MATTISON CEO 443-413-0832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded (Licence: MD 0290) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2008-03-05 |