| NPI | 1124772520 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: FL 692345396) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: FL 692345396) |
| Enumeration Date | 2022-02-05 |
| Last Update Date | 2022-02-05 |