NPI | 1922610088 |
---|---|
Former Legal Business Name | EAGLE PHOENIX RESIDENTIAL & BEHAVORIAL HEALTH SERVICES LLC |
Entity Type | Organization |
Authorized Contact | MONICA LOTORIA BALLOU CEO/Owner 434-429-2649 |
Organization Subpart ? | No |
Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
Enumeration Date | 2020-08-20 |
Last Update Date | 2020-08-20 |