| NPI | 1306517677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS GANG Director 571-422-6705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-09-25 |
| Last Update Date | 2021-09-25 |