| NPI | 1053804716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDRA DAVIS Program Manager/Administrator 817-523-1719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2018-06-07 |