| NPI | 1396504155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FULAI DIOM COO 443-213-8243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 1041C0700X Social Worker, Clinical | |
| 106S00000X Behavior Technician | |
| 133N00000X Nutritionist | |
| 163W00000X Registered Nurse | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2024-03-15 |
| Last Update Date | 2025-08-11 |