| NPI | 1912320383 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ESTRENETA CAMMOCK Administrator 386-561-8175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: FL al12243) |
| Enumeration Date | 2014-01-21 |
| Last Update Date | 2014-01-21 |