| NPI | 1194371674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULSHAUNA J FUGETT Member 909-619-9321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 347C00000X Private Vehicle |
| 347E00000X Transportation Broker | |
| 385H00000X Respite Care | |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2023-06-22 |