| NPI | 1215537717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACINDER ROSEANN KING-FULTON Program Director 469-478-0573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 311Z00000X Custodial Care Facility |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| 313M00000X Nursing Facility/Intermediate Care Facility | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 385H00000X Respite Care | |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2023-04-10 |