| NPI | 1215341979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIARA LASHAE JOHNSON Manager 601-918-6415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2014-06-19 |