| NPI | 1376733659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIGID PETERSON Controller 800-582-5260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2007-08-01 |