| NPI | 1043024417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADIZA J SULLEY Owner 062-329-4949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2025-02-05 |
| Last Update Date | 2025-02-05 |