| NPI | 1639988678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JA'VAN JEFFERSON Managing/ Member 571-830-9256 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2025-01-04 |
| Last Update Date | 2025-01-04 |