| NPI | 1760136386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRE J CAMPBELL Waiver Provider 951-218-3475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-02-11 |
| Last Update Date | 2022-02-11 |