| NPI | 1215604863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | QUEEN AGBONIFO Program Manager 972-375-3354 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2021-08-23 |