| NPI | 1134729213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA ESSIM Director 571-245-8717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2020-10-28 |