| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 251B00000X Case Management |
| 253J00000X Foster Care Agency |
| 310400000X Assisted Living Facility |
| 3104A0625X Assisted Living Facility Assisted Living, Mental Illness |
| 3104A0630X Assisted Living Facility Assisted Living, Behavioral Disturbances |
| 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| 320700000X Residential Treatment Facility, Physical Disabilities |
| 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| 374U00000X Home Health Aide |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2024-06-11 |