| NPI | 1356032817 |
|---|---|
| Other Name | BOYS REPUBLIC - GRAVES STRTP |
| Entity Type | Organization |
| Authorized Contact | MICHAEL ROA Clinical Supervisor/Head Of Service 909-925-8134 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2023-12-29 |