| NPI | 1336529387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN JAMES LOVELADY Regional Director 862-284-4565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center Developmental Disabilities |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2024-10-07 |