| NPI | 1548877657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY PACE Administrator 209-475-8792 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2021-05-04 |