| NPI | 1710368188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN M YANKOUSKI Director 844-823-7865 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2015-06-11 |