| NPI | 1629099890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA LYNN CARLSON Clinical Director 352-671-2777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: FL 1342AD5690) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2022-07-21 |