| NPI | 1710501648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIAJUANA COLES Executive Director 443-635-1492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-06-06 |
| Last Update Date | 2020-06-06 |