| NPI | 1629674742 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 251S00000X | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | |
| Enumeration Date | 2020-12-05 |
| Last Update Date | 2020-12-05 |