| NPI | 1396116919 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: IN 27045161A) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: IN 27045161A) |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2015-10-08 |