| NPI | 1306608195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SADIO SYKES Administer 571-484-4472 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2024-01-26 |
| Last Update Date | 2025-01-13 |