| NPI | 1205651437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYTEILA M ROACH Owner 228-265-0331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2024-11-21 |
| Last Update Date | 2024-11-21 |