| NPI | 1396409413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIANA GRIMES Owner 234-419-4476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2021-10-25 |