| NPI | 1285517862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARNIECE GREENE FOUNTAIN Executive Director 276-358-0076 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2025-07-30 |
| Last Update Date | 2025-07-30 |