| NPI | 1780119917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MURIEL S COUCOU Cero 863-212-5331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2017-04-25 |