| NPI | 1518625896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAKEDA ESSIM Program Director 571-351-3476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-12-03 |
| Last Update Date | 2021-12-03 |