| NPI | 1992295984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY NYALITA Administrator 302-530-9489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: AZ BH5417) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2018-05-15 |