| NPI | 1225710825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIEL CROWLEY Owner 267-575-2225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2023-08-02 |