| NPI | 1477068757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB GELLES Director 800-588-5898 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2017-12-07 |