| NPI | 1487338570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONY ODINDE OPOGGEN Administrator 678-793-3963 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2023-06-09 |
| Last Update Date | 2023-06-09 |