| NPI | 1013725654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIJAH KIMBLE Executive Director 424-485-6684 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2024-12-30 |
| Last Update Date | 2025-01-10 |