| NPI | 1164111464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEESEAN BOLLING Director 214-698-9371 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| 311Z00000X Custodial Care Facility | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2023-05-02 |