| NPI | 1104631787 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2025-02-11 |
| Last Update Date | 2025-02-11 |