| NPI | 1205362217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL ROSE Manager 347-221-8616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |