| NPI | 1356095202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAMION S PETERS Waiver Provider 631-796-1567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-02-09 |
| Last Update Date | 2022-02-09 |