| NPI | 1740848845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FATMATA ALIE SANKOH Program Director 571-263-5428 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 347C00000X Private Vehicle |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2019-06-03 |