| NPI | 1265185003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness | |
| 311Z00000X Custodial Care Facility | |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2022-02-01 |