| NPI | 1154176378 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWANDA SHEAD Manager 682-730-6030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-04-22 |