| NPI | 1437211760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK F. WILSON Administrator 562-809-0042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: CA 960000997) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2020-08-22 |