| NPI | 1720832090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AZEEZ AGBAJE Manager 929-331-7694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-04-15 |