| NPI | 1639943947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA ROBERT Owner 682-301-2042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| 253Z00000X In Home Supportive Care | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 385H00000X Respite Care | |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2023-11-08 |