| NPI | 1396595088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLLIS YOUNG Owner 469-556-6473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2024-04-11 |