| NPI | 1255947396 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEVON LEWIS Owner 347-922-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2020-09-22 |