| NPI | 1407402316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIA ROSS Owner 619-366-1546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2022-09-22 |