| NPI | 1336478304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN STUPAK President 267-419-8913 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children (Licence: FL 0542AD9709) |
| Enumeration Date | 2009-12-21 |
| Last Update Date | 2009-12-21 |