| NPI | 1700362191 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIMONTE EVANS Owner 678-515-6507 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NV nv-20181511294) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2018-07-18 |