| NPI | 1770335218 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YUSHEKA M GARNER Operations Manager 346-543-2669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2024-04-05 |
| Last Update Date | 2024-04-15 |