| NPI | 1134475635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL KOEHLER Recreation Therapy Director 866-753-1374 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2012-08-02 |