| NPI | 1528755428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARICA JOHNSON Owner 318-693-0059 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2024-07-16 |