| NPI | 1174492292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA A MADUEKWE Program Manager 346-585-3191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2025-11-05 |
| Last Update Date | 2025-11-05 |