| NPI | 1902635758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORINE NZOFANG Program Manager 508-215-6186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-07-30 |
| Last Update Date | 2024-07-30 |