| NPI | 1639220619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT IAN COHEN COO 800-388-5150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: FL 4023096) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2023-03-12 |