| NPI | 1518507532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYSSEEVETH SERRANO Owner/Provider 772-519-4053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2020-01-07 |