| NPI | 1720473739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD L ROSS CEO 469-901-0044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2015-04-06 |