| NPI | 1639278377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY CHURCH Executive Director 813-872-6250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2020-10-22 |