| NPI | 1114625530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA MOJICA Director Of Billing And Credentiali 917-485-7291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-02-16 |
| Last Update Date | 2023-05-31 |