| NPI | 1275277667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANISHA LAWRENCE Owner 623-210-5169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2022-04-22 |