| NPI | 1629799077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSETTE N WAKANABO Program Manager 508-371-8503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-09-05 |
| Last Update Date | 2022-09-05 |