| NPI | 1073105904 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 3747A0650X Technician, Attendant Care Provider (Licence: FL 237231) |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2021-09-28 |