| NPI | 1841843190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN LEE WHITTLE Owner 725-400-8328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2020-02-20 |