| NPI | 1568063527 |
|---|---|
| Doing Business As | 2525 PRESTON AVENUE |
| Entity Type | Organization |
| Authorized Contact | ANNA TODD Operations Business Manager 800-299-5161 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2020-11-05 |