| NPI | 1528740347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELINA M LOPEZ Program Manager 945-240-0107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2023-08-01 |
| Last Update Date | 2023-08-01 |