| NPI | 1114671823 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: 14001003) |
| Enumeration Date | 2022-02-10 |
| Last Update Date | 2022-02-10 |