| NPI | 1407620131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY LOUISE THOMAS Executive 888-759-4917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X |
| Additional Taxonomies | 261QA0600X Clinic/Center, Adult Day Care |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QM0801X | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2023-11-13 |