| NPI | 1285197251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANTELL WALKINE Owner 772-828-3045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2022-05-16 |