| NPI | 1770124265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARON CHRISTOPHER RANDOLPH Director 619-600-9595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 101Y00000X Counselor |
| 251B00000X Case Management | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| 385H00000X Respite Care | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2019-10-05 |
| Last Update Date | 2019-10-05 |