| NPI | 1902142342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOPHIA D LEWIS Utilization Review Manager 813-626-7250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2012-12-12 |