| NPI | 1336958974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRONDA HUDDLESTON Owner 260-704-5466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness |
| Additional Taxonomies | 163W00000X Registered Nurse |
| 251J00000X Nursing Care | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2025-01-07 |
| Last Update Date | 2025-01-14 |