| NPI | 1053834341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANDRA PHILLIPS Provider 904-505-4972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2019-04-18 |