| NPI | 1720719743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY M KOTSIRIS CEO 810-908-0623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2022-11-03 |