| NPI | 1336602093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAKYNA R HATHORN Owner 904-418-1440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2024-04-19 |