| NPI | 1124474630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANIESE GRIFFITHS Senior Biller 914-220-4353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2016-05-13 |