| NPI | 1164703625 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| 310500000X Intermediate Care Facility, Mental Illness | |
| 101Y00000X Counselor | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 261QM0801X | |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2011-09-22 |