| NPI | 1316637689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQULENE TRINETTE TARVER Owner/ Program Administrator 904-536-4318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2023-10-16 |