| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 385H00000X Respite Care |
| 385HR2050X Respite Care, Respite Care Camp |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child |
| Enumeration Date | 2025-09-01 |
| Last Update Date | 2025-09-01 |