| NPI | 1114263332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MA.LOURDES C GONZALES Owner/Medical Director 516-472-1710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 243713) |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility (Licence: NY 243713) |
| Enumeration Date | 2012-12-14 |
| Last Update Date | 2014-03-23 |