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 |