| NPI | 1679802458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN STUPAK President 267-419-8913 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2009-12-08 |