| NPI | 1508080136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN RUSSELL PROVOST Controller 860-539-7745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: RI 46702) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2023-11-01 |