| NPI | 1215780192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ABDIAZIZ IBRAHIM Owner 408-978-2579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-04-09 |
| Last Update Date | 2024-04-09 |