| NPI | 1528577483 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: TX 16071202) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: TX 16071202) |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2017-09-22 |