| NPI | 1063330090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARQUITA HOLLEY Owner 267-210-9250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2026-07-07 |
| Last Update Date | 2026-07-07 |