| NPI | 1063719284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOPHIA BRINSON Administrator 386-546-3383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: FL 230189) |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2011-02-24 |