| NPI | 1083067896 |
|---|---|
| Other Name | EIJAZ KAYTENNAE SHABAZZ EL |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| Enumeration Date | 2016-07-16 |
| Last Update Date | 2023-06-06 |