| NPI | 1689408064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANAH FORBES Cna 347-574-8233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-08-28 |
| Last Update Date | 2024-08-30 |