| NPI | 1588619365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER O BOUCHARD President 386-842-5501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2020-08-22 |