| NPI | 1639741440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONY PEAVY Executive Director 346-291-0675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 101Y00000X Counselor |
| 172A00000X Driver | |
| 174200000X Meals | |
| 177F00000X Lodging | |
| 251C00000X Day Training, Developmentally Disabled Services | |
| 251S00000X | |
| 252Y00000X Early Intervention Provider Agency | |
| 253J00000X Foster Care Agency | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QF0050X Clinic/Center, Family Planning, Non-Surgical | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 310400000X Assisted Living Facility | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2021-08-02 |