| NPI | 1518564608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE DINGLE Owner 912-996-9261 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2020-10-02 |