| NPI | 1124909882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISSY IFFORD Licensee 424-391-0041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities |
| Enumeration Date | 2025-09-09 |
| Last Update Date | 2025-09-09 |