| NPI | 1134941115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB GELLES Owner 917-225-0383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2024-10-30 |
| Last Update Date | 2024-10-30 |