| NPI | 1164631214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MENDY MIDDLEBROOK Temporary Administrator 641-872-1524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: IA RMR-413) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2008-08-01 |