| NPI | 1114129814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA GIBSON Administrator 559-486-3146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: CA 1006) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2020-08-22 |