| NPI | 1225697493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY CODY Billing Manager 516-676-2388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2019-06-11 |