| NPI | 1033880059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL JACKSON Owner 980-353-6536 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 174200000X Meals |
| 177F00000X Lodging | |
| 251B00000X Case Management | |
| 251E00000X Home Health | |
| 251S00000X Community/Behavioral Health | |
| 252Y00000X Early Intervention Provider Agency | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2021-09-21 |
| Last Update Date | 2025-07-25 |