| NPI | 1538730650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMONE SMITH Owner 904-930-0056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2022-03-16 |