| NPI | 1366758062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANITA SHANTA SULLIVAN Program Manager 936-856-6136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 253J00000X Foster Care Agency | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 372600000X Adult Companion | |
| 376J00000X Homemaker | |
| 385H00000X Respite Care | |
| 385HR2050X Respite Care, Respite Care Camp | |
| Enumeration Date | 2010-08-19 |
| Last Update Date | 2021-03-12 |