| NPI | 1215580725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TED PHILLIPS Administrator 888-958-3524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 251E00000X Home Health |
| 251J00000X Nursing Care | |
| 253Z00000X In Home Supportive Care | |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 261QH0100X Clinic/Center, Health Services | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 385H00000X Respite Care | |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2019-07-23 |