| NPI | 1811255888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRIN MOLLETTA Executive Director 267-639-3135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children (Licence: PA 137880) |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children (Licence: PA 807417) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2012-04-27 |