| NPI | 1093991069 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children | |
| 164X00000X Licensed Vocational Nurse (Licence: TX 210151) | |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2012-07-26 |