| NPI | 1407468986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CICELY JACKSON Owner 386-759-0353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2020-08-17 |
| Last Update Date | 2020-08-17 |