| NPI | 1144873308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANISHA PORRECA COO 888-700-5053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2019-07-17 |