| NPI | 1124443346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACEK DYGDON Owner 386-315-0899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility (Licence: FL AL5675) |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2014-02-25 |