| NPI | 1174305007 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: TN I000000022582) |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2024-05-06 |