| NPI | 1265304679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MACK Authorized Official/ Owner 346-279-8175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2025-09-23 |
| Last Update Date | 2025-09-23 |