| NPI | 1073027645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNETTE LYNN WILSON Owner 702-706-4969 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2017-11-18 |
| Last Update Date | 2018-07-09 |