| NPI | 1518296698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRIE YVETTE SMITH Ower/Operator 512-669-3808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 310500000X Intermediate Care Facility, Mental Illness |
| Enumeration Date | 2009-12-18 |
| Last Update Date | 2013-01-03 |