| NPI | 1225640279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM CLOYD Member 619-888-5114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2020-08-20 |