| NPI | 1588490650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY BLAKE Owner 346-300-6131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 251B00000X Case Management |
| 171M00000X Case Manager/Care Coordinator | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2024-09-13 |
| Last Update Date | 2025-10-03 |