| NPI | 1194540534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAUDE BRYANT Regional Administrator 479-650-7083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-11-20 |
| Last Update Date | 2025-05-07 |