| NPI | 1306487426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENARD A SODEK Controller 817-678-7428 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2021-06-04 |