| NPI | 1235621335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAYLOR BANNER Director 980-888-0251 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2023-01-10 |