| NPI | 1104991066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT IAN COHEN COO 800-388-5150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MN 804038-3-WS) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2023-03-05 |