| NPI | 1376521187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN A COSIMI CEO/President 386-236-1811 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: FL 1285) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2022-01-28 |