| NPI | 1861204638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA PAYTON RN 567-322-4747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2025-01-21 |
| Last Update Date | 2025-01-21 |