| NPI | 1386465151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHEVANTE JOHNSON Secretary/ Owner 423-805-6093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2024-10-23 |
| Last Update Date | 2024-10-23 |