| NPI | 1134875024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BUSAYO OLABODE Program Administrator 443-695-3992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2022-03-01 |