| NPI | 1386054153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVA MARIE ASARISI Certified Nursing Assistant 386-209-4417 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: FL 1558538942) |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2014-05-02 |