| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 251V00000X Voluntary or Charitable |
| 310400000X Assisted Living Facility |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 324500000X Substance Abuse Rehabilitation Facility |
| 385H00000X Respite Care |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2024-11-18 |