| NPI | 1265878409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN JEAN MACDAVID Mental Health Counselor 1716-901-2762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: NY 004189) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NY 004186) |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NY 004189) | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2013-05-15 |