| NPI | 1124887344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BESSIE L ELMORE Executive Director 984-219-1001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2024-03-18 |