| NPI | 1912409913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL BERGSTEN Managing Member 937-825-6622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2018-03-06 |