| NPI | 1891293056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON SCOTT LYNCH Member 304-771-2184 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: WV 23489223) |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2018-01-23 |