| NPI | 1366861197 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: KS 2014) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2014-04-09 |