| NPI | 1104671015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHATAYA BOSWELL Director 848-299-2064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2024-04-23 |
| Last Update Date | 2024-04-23 |