| NPI | 1336863117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASMINE O'NEIL HEFFNEY CEO 980-219-1589 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2024-06-25 |