| NPI | 1982486080 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: AZ BH8805) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH8805) |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2023-10-16 |