| NPI | 1821668229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCEE PATRICK Administrator/Program Director 800-575-9750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2021-11-20 |