NPI | 1124907852 |
---|---|
Entity Type | Organization |
Authorized Contact | DAVID STAMPLEY Manager 708-715-4713 |
Organization Subpart ? | No |
Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
Enumeration Date | 2025-08-27 |
Last Update Date | 2025-08-27 |