| NPI | 1053192096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OWEN GARDNER Owner 301-928-4725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| Enumeration Date | 2023-10-06 |
| Last Update Date | 2024-04-05 |