| NPI | 1124586599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE MACK MINTZ Administrator 803-546-0298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2019-03-05 |