| NPI | 1114416872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL TRAMAINE SIMMONS Owner 904-894-8386 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse |
| 251J00000X Nursing Care | |
| 372600000X Adult Companion | |
| 376J00000X Homemaker | |
| 376K00000X Nurse's Aide | |
| 385H00000X Respite Care | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2018-08-27 |