| NPI | 1164293700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MA. ROSE DECENA President 571-275-4329 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 310500000X Intermediate Care Facility, Mental Illness |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2024-01-11 |
| Last Update Date | 2024-01-11 |