| NPI | 1528686789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERENA D HOOVER Owner/Operator 904-219-9210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2020-07-13 |