| NPI | 1518573609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ESTHER CARINE KALOMBO Program Manager 817-323-3591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2020-09-23 |