| NPI | 1053695924 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: FL 100012805) |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2011-10-10 |