| NPI | 1932096419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOLOMON DEFASE BASORE Administrator 614-804-1274 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2025-06-18 |
| Last Update Date | 2025-06-18 |