| NPI | 1134686736 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY OKOH Executive Director 424-750-1008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 253J00000X Foster Care Agency |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2019-03-01 |
| Last Update Date | 2019-03-01 |