| NPI | 1902470487 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE SHANTEA DUPREE Director 862-236-0456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251300000X Local Education Agency (LEA) |
| 251C00000X | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2021-05-18 |