| NPI | 1295446557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNETTA DILLON Owner 267-516-1092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251X00000X Supports Brokerage |
| Additional Taxonomies | 261QA0600X Clinic/Center, Adult Day Care |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 253Z00000X In Home Supportive Care | |
| 251B00000X Case Management | |
| 251E00000X Home Health | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2022-12-07 |
| Last Update Date | 2022-12-11 |