| NPI | 1558736587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARONDA HUSSEY Provider 904-229-1884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2015-12-02 |