| NPI | 1134781958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEYANA MOORE CEO 980-219-3318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2021-10-06 |