| NPI | 1528317005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BREANN DEBOER Licensee 559-350-3695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: CA 550001291) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2012-08-30 |