| NPI | 1699247635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEROY STANFORD CEO 856-302-6437 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2018-12-31 |
| Last Update Date | 2020-09-18 |