| NPI | 1215220256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TATIANA GAVALCINOVA Owner / Operator 937-426-4579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2011-05-24 |