| NPI | 1760989917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONITA F BULLOCK Business Manager 301-270-4750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: DC TBA) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2018-04-12 |