| NPI | 1043806979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONELL MOFFETT-PRINCE Owner 469-450-8831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2020-12-15 |
| Last Update Date | 2022-10-25 |