| NPI | 1407587132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIVIEN BAZUAYE Program Manager 916-868-3989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2024-09-05 |