| NPI | 1689269250 |
|---|---|
| Doing Business As | CLEMENTINE FAIRFAX |
| Entity Type | Organization |
| Authorized Contact | MIKE BAGLEY Chief Financial Officer 305-663-1876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2024-10-17 |