| NPI | 1548654932 |
|---|---|
| Doing Business As | SERVICES FOR THE UNDERSERVED FOUNTAIN ICF |
| Entity Type | Organization |
| Authorized Contact | LIN YANG Director Medicaid Billing 917-408-1642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NY 7559303) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2015-03-24 |