| NPI | 1104608876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLA OLATOKUNBO ADEGBOLA Program Manager 832-888-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2023-10-18 |
| Last Update Date | 2024-02-16 |