| NPI | 1386351633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRISTOL THERIEN-DOUGLAS Regional Administrator Director 772-408-9588 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM3000X Clinic/Center, Medically Fragile Infants and Children Day Care |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2022-11-04 |