| NPI | 1073265450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA THOMAS Waiver Provider 813-735-8176 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-01-26 |
| Last Update Date | 2022-01-26 |