| NPI | 1104558097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONI FOUNTAIN Executive Director 302-275-8938 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2024-12-06 |