| NPI | 1023988680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KASSANDRA K WEBB Owner 319-210-5660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2025-11-10 |
| Last Update Date | 2025-11-10 |