| NPI | 1598925141 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDUARDO LOPEZ Director 239-303-1689 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: FL 089319) |
| Additional Taxonomies | 385H00000X Respite Care (Licence: FL 089319) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2008-06-16 |