| NPI | 1114741121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA PRATT Owner 346-243-1212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 251B00000X Case Management | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2024-11-15 |
| Last Update Date | 2026-06-04 |