| NPI | 1174029201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA L STAYTON Owner 904-377-1218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| 253Z00000X In Home Supportive Care | |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2018-06-27 |