| NPI | 1649599135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA Z. MARTIN Lpn 347-853-2849 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NY 273750-1) |
| Enumeration Date | 2010-05-23 |
| Last Update Date | 2010-05-23 |