| NPI | 1730690694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY COPELAND CEO 347-228-2665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: VA 2590-03-001) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2024-05-22 |