| NPI | 1487111944 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LA'STACIA BUSH Authorized Official 386-983-0154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 251J00000X Nursing Care |
| 251S00000X | |
| 253J00000X Foster Care Agency | |
| 253Z00000X In Home Supportive Care | |
| 313M00000X Nursing Facility/Intermediate Care Facility | |
| 314000000X Skilled Nursing Facility | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 385H00000X Respite Care | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2019-02-20 |