| NPI | 1104591478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINA E BESONG Program Manager 832-494-0623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2021-08-10 |