| NPI | 1265104434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMAN VATRELL COOPER Owner 980-900-9574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2025-01-28 |