| NPI | 1639546864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALIE BOMBOLAI BANGURA Deputy CEO/Program Specialist 267-449-9976 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2015-08-24 |