| NPI | 1699421735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BELINA SURUJON Contracting & Licensing Director 754-300-3120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2022-02-28 |
| Last Update Date | 2025-09-23 |