| NPI | 1346021367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAKEITHA VAIL Billing Specialist 912-658-1149 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2023-10-06 |
| Last Update Date | 2023-10-06 |