| NPI | 1356948954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACHONIQUIE EVANS Owner/Director 567-225-4008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2020-10-06 |