| NPI | 1245509504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LA TONYA S POLK Program Manager 903-315-8302 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 171W00000X Contractor | |
| Enumeration Date | 2011-12-15 |
| Last Update Date | 2026-04-15 |