| NPI | 1790451839 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA BRUCE Owner 601-807-3833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| 251S00000X | |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2021-08-19 |