| NPI | 1346681129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG ALAN BLAIR Manager 386-837-3125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: FL 678316396) |
| Additional Taxonomies | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: FL 678316396) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2013-07-09 |