| NPI | 1346840261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JALISA PRECIOUS JACKSON Director 980-258-2704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2020-10-29 |