| NPI | 1366194136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAZEL SERIEUX Medicaid Waiver Provider 407-585-9711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-01-24 |
| Last Update Date | 2022-01-24 |