| NPI | 1699355818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLEE KATHRYN VANCE Director Of Utilization Management 386-668-4774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2021-05-13 |