| NPI | 1063758282 |
|---|---|
| Doing Business As | MONTELISSA RESIDENTIAL |
| Entity Type | Organization |
| Authorized Contact | DENISE JOHNSON MASON CEO 256-345-3996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2012-12-15 |
| Last Update Date | 2012-12-15 |