| NPI | 1417321100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON DAVIS Physical Therapist 410-212-2419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251T00000X PACE Provider Organization (Licence: CA 9559) |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services (Licence: CA 9559) |
| 310400000X Assisted Living Facility (Licence: CA 9559) | |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2015-11-18 |