| NPI | 1164001053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRINA VERNELL BOYD President 980-213-1290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 347C00000X Private Vehicle | |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child | |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2024-05-02 |