| NPI | 1710630124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK WATERS State Director 706-200-8677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2022-01-27 |