| NPI | 1225169659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA KAY ROARK Owner 660-826-0244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2020-08-22 |