| NPI | 1497557862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY PAGE Authorized Representative 267-581-3923 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2025-03-26 |
| Last Update Date | 2025-04-04 |