| NPI | 1326700550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONY NELSON Owner/Program Manager 346-800-7135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2026-05-07 |