| NPI | 1780525386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM DARUS SMITH Program Director 701-200-1571 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 252Y00000X Early Intervention Provider Agency | |
| Enumeration Date | 2026-04-06 |
| Last Update Date | 2026-05-27 |