| NPI | 1306960091 |
|---|---|
| Other Name | KANNER JACKSON VILLA |
| Entity Type | Organization |
| Authorized Contact | FRAN WAGNER National Director, Ar 610-542-3084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: PA 132880) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: PA 112050) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2010-08-31 |