| NPI | 1336162593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY LYNN CARPENTER Co Owner/Billing 512-280-3665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: TX 001007356) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2020-08-22 |