| NPI | 1821789942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL COSTELLO Administrator 937-231-1838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2023-05-18 |
| Last Update Date | 2023-09-21 |