| NPI | 1639683469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTWON TELLIS Owner 702-285-4138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2017-12-01 |