| NPI | 1003237603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BANNISTER Owner 305-752-2684 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: FL 6905352) |
| Enumeration Date | 2013-12-27 |
| Last Update Date | 2013-12-27 |