| NPI | 1326385956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS LAMONT DAVIS Director 305-720-3255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: GA CLA002023) |
| Additional Taxonomies | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: GA CLA002023) |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2013-01-16 |