| NPI | 1144980756 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AREANNA BENNETT Member 906-250-0956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| 253Z00000X In Home Supportive Care | |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 310400000X Assisted Living Facility | |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 385H00000X Respite Care | |
| 251C00000X Day Training, Developmentally Disabled Services | |
| 251E00000X Home Health | |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child | |
| Enumeration Date | 2021-12-22 |
| Last Update Date | 2022-07-09 |