| NPI | 1538348883 |
|---|---|
| Other Name | SOUTH HIMES GROUP HOME |
| Entity Type | Organization |
| Authorized Contact | DANE MCCAL JONES Medicaid Waiver Provider Administra 813-909-3710 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2007-11-02 |