| NPI | 1104500123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLETUS A FONMEDIG Director 301-437-7749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2023-06-12 |