| NPI | 1487514295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: TX 001011661) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: TX 001011661) |
| 101Y00000X Counselor | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 385H00000X Respite Care (Licence: TX 001011661) | |
| Enumeration Date | 2025-11-13 |
| Last Update Date | 2026-01-23 |