| NPI | 1588490650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY BLAKE Owner 346-300-6131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 251B00000X Case Management | |
| 251S00000X | |
| Enumeration Date | 2024-09-13 |
| Last Update Date | 2024-09-27 |