| NPI | 1104013754 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: MO 10063429) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2012-07-18 |