| NPI | 1285680587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT H DEPOL Owner 678-990-0510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2020-08-22 |