| NPI | 1003394479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MN 1094965-1-HCBS) |
| Additional Taxonomies | 253J00000X Foster Care Agency (Licence: MN 1094965-1-HCBS) |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2018-08-01 |