| Name | Value |
|---|---|
| PROVIDER TYPE | Residential Treatment Facilities |
| CLASSIFICATION | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| DEFINITION | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities |
| STATUS | Active |
| X12 CODE | 320900000X |
| INDIVIDUAL/NON | NON-INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5255054 |
| EFFECTIVE DATE/TIME |
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