| NPI | 1326587049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM HUDSON Program Administrator 51023-676-3307 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: CA 4002-5526) |
| Enumeration Date | 2017-02-14 |
| Last Update Date | 2017-02-14 |