| NPI | 1821794454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY BOLANOS Member 626-710-2595 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251S00000X |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2024-08-27 |