| NPI | 1194615682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OSONG EGBE CEO 567-207-5745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2025-07-07 |
| Last Update Date | 2025-07-07 |