| NPI | 1558115964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERAQUISA NESBY Owner 662-274-9477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2024-04-12 |
| Last Update Date | 2024-04-12 |