| NPI | 1073130936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA RENEE EDWARDS Program Manager/Owner 682-414-0899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2024-11-18 |