| NPI | 1780428813 |
|---|---|
| Other Name | NA |
| Entity Type | Organization |
| Authorized Contact | MONIQUE TIDWELL CEO 716-316-3729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2024-06-24 |