| NPI | 1639818859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW BROKENBOROUGH Owner 321-594-0057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-06-04 |
| Last Update Date | 2022-06-04 |