| NPI | 1548602477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLEN L LANCE Owner 660-815-5270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251C00000X |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2013-11-12 |