| NPI | 1508917071 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAQUITA SHANELLE BUCKHOLTZ Administrator 904-472-0066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: FL 691047596) |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2011-06-17 |