| NPI | 1811613920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT IAN COHEN COO 800-388-5150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2023-03-04 |