| NPI | 1508169657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALVIN PAYNE President 321-508-4639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2010-12-13 |