| NPI | 1154511921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY M DOLD Controller 718-906-5440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NY 7455449) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2007-07-27 |