| NPI | 1558837104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: TN L000000017408) |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2018-10-22 |