| NPI | 1316776529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLEENA DAVIS Member 346-634-8887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2024-07-29 |
| Last Update Date | 2024-07-29 |