| NPI | 1073851036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 385H00000X Respite Care | |
| Enumeration Date | 2013-01-26 |
| Last Update Date | 2013-01-26 |