| NPI | 1609092477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN W FANNING Executive Director 304-267-2763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: WV 36) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |