| NPI | 1295324408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUNZARAE JOHNSON Owner 567-202-7808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 251E00000X Home Health |
| 251S00000X | |
| 253Z00000X In Home Supportive Care | |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2021-01-12 |