| NPI | 1508146242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRISTAN JOSEPH HOGAN Program Manager/Part Owner 903-917-1115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2011-08-25 |