| NPI | 1700694320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEENEN MAPP Director 833-774-9633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 251S00000X Community/Behavioral Health | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2024-12-28 |
| Last Update Date | 2026-03-18 |