| NPI | 1164266375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMON FREDRICK GADDIE CEO 909-204-8854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251G00000X Hospice Care, Community Based |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2024-06-21 |
| Last Update Date | 2024-06-21 |