| NPI | 1174324206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMESE CARLSON Owner 531-203-9070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2025-03-24 |