| NPI | 1720778756 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE BOEHM President 712-210-6296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251C00000X |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2023-05-12 |
| Last Update Date | 2023-05-12 |