| NPI | 1073839221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY DENISE WILLIAMS Owner 936-414-0988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2023-04-10 |