| NPI | 1497512610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YASMIN MICHELLE JACKSON Owner 817-996-0402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-03-04 |
| Last Update Date | 2024-03-04 |