| NPI | 1164199410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATASHA JACKSON Owner 619-846-5650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 251E00000X Home Health |
| 253Z00000X In Home Supportive Care | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2021-09-30 |