| NPI | 1962090951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY JOHNSON Qmha 541-751-5040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2021-01-05 |