| NPI | 1295423648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA KATHLINE COURSEY Owner 267-216-7239 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2023-04-25 |