| NPI | 1790229094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA MACCHIO Credentialing/Billing Manager 843-299-1554 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: MD 905304) |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2016-12-06 |