| NPI | 1447891171 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: TN 1000000025070) |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2019-10-03 |