| NPI | 1356764823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW HAWKINS President 386-957-3907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: FL AL12247) |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2014-02-03 |