| NPI | 1104560838 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANTA DOSS Owner 618-974-4807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 172A00000X Driver |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2022-04-27 |