| NPI | 1912456856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICKEY MANNING CEO 805-886-4223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility (Licence: MT PAP-PAP-LIC-614) |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2018-09-28 |