| NPI | 1366277642 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 253J00000X Foster Care Agency |
| 3104A0625X Assisted Living Facility Assisted Living, Mental Illness | |
| 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2024-09-05 |
| Last Update Date | 2024-09-05 |