| NPI | 1578069415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNBOOSCO OBOMA Owner 848-214-0024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2018-03-31 |
| Last Update Date | 2018-03-31 |