| NPI | 1649890146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE WILLIAM BOEHM Owner 712-210-6296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2020-04-24 |