| NPI | 1730468307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY CLOYD Secretary 904-605-4986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251S00000X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2023-06-19 |