NPI | 1104679422 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
Enumeration Date | 2024-04-08 |
Last Update Date | 2024-05-29 |