| NPI | 1598396905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONITA F BULLOCK Authorized Official 301-270-4750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2020-02-04 |