| NPI | 1164551701 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: MO 2573-9130) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2007-07-08 |