| NPI | 1811354400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TO BE DETERMINED Unknown 111-111-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2016-02-24 |