| NPI | 1306719679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERAD CHANCELLOR Owner 469-337-3711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 251T00000X PACE Provider Organization |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| Enumeration Date | 2025-09-24 |
| Last Update Date | 2025-09-24 |