| NPI | 1104590363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIETTE EKI Director 346-247-4934 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251B00000X Case Management |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2023-07-03 |