| NPI | 1720117161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN GIBSON Director 917-602-0156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 385H00000X Respite Care |
| Enumeration Date | 2007-03-03 |
| Last Update Date | 2008-06-30 |