| NPI | 1104780931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL DAVENPORT Director 346-545-3431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 174200000X Meals |
| 177F00000X Lodging | |
| 251B00000X Case Management | |
| 251E00000X Home Health | |
| 251G00000X Hospice Care, Community Based | |
| 253Z00000X In Home Supportive Care | |
| 310400000X Assisted Living Facility | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2025-12-15 |
| Last Update Date | 2025-12-15 |