| NPI | 1467102780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAMAR FERGUSON Administrator 628-628-7255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2022-03-28 |