| NPI | 1316445091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COERIC RILEY Owner 228-209-0984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2018-01-26 |
| Last Update Date | 2019-02-04 |