| NPI | 1023984713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERIC FADEL DOUNGUE TIYO CEO 405-508-1338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2025-10-11 |
| Last Update Date | 2025-10-13 |