| NPI | 1447766670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNABELLE COOKS Owner 702-204-2715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2018-12-05 |