| NPI | 1477174407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESHALL HILL Owner 890-309-6863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 251S00000X |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2020-08-13 |