| NPI | 1205493343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVONDA MOORE HARGROVE Owner 813-606-0488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 251E00000X Home Health | |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| 385HR2050X Respite Care, Respite Care Camp | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2019-05-23 |