| NPI | 1427405083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE D GRAHAM Manager 817-443-8775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: TX 32090000X) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2016-05-24 |