| NPI | 1649773540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY JO MCDONALD Billing Supervisor 228-863-1132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MS M8858) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2018-03-16 |