| NPI | 1124417506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED BALLARD Owner 512-423-0178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 261QA0600X Clinic/Center, Adult Day Care |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2022-07-01 |