| NPI | 1235554783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAM D WHITAKER Vice President Of Programs 863-687-8811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL 100035936) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: FL 100035936) |
| Enumeration Date | 2014-02-20 |
| Last Update Date | 2014-02-20 |