| NPI | 1053178475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL HAMMOND Owner 267-625-5177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-03-01 |
| Last Update Date | 2024-07-09 |