| NPI | 1124587456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSANNA A A Owner 617-899-1338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2019-03-16 |
| Last Update Date | 2019-03-16 |