| NPI | 1033656939 |
|---|---|
| Former Name | JACQUELINE DENISE THOMAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-080172) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2017-01-30 |