| NPI | 1376182683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN A FORNEY CEO 443-815-1171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2020-06-17 |