| NPI | 1912443094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEIZA STANLEY Owner 640-457-8542 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: PA CW016642) |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2017-05-04 |