| NPI | 1417131137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY BOGGS Owner/Director 817-565-4052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2007-12-18 |