| NPI | 1497497234 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN DISTEFANO Consultant 352-317-3214 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2022-04-12 |