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 |