| NPI | 1114331501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA MITCHELL Provider 904-219-8551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2014-06-13 |