| NPI | 1639741630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK DERON BRADLEY Owner 832-216-3356 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251E00000X Home Health |
| 251S00000X | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2021-07-11 |
| Last Update Date | 2021-07-11 |