| NPI | 1205308459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUCONDRA HOLLOWAY Owner 254-421-0678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 251C00000X |
| 253Z00000X In Home Supportive Care | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| Enumeration Date | 2018-12-28 |
| Last Update Date | 2018-12-28 |