| NPI | 1417723529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JINLAN LU Manager 929-575-0958 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2023-11-29 |
| Last Update Date | 2023-11-29 |