| NPI | 1457231003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KETTLY DERIVAL CEO 954-546-0667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WC1500X Registered Nurse Community Health |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2025-09-04 |
| Last Update Date | 2025-09-04 |