| NPI | 1154985877 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG HEINTZELMAN Owner 330-617-2087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2019-06-11 |