| NPI | 1013113554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKY WALLACE CEO 904-723-6049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services (Licence: FL F001) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2022-07-21 |