| NPI | 1649426065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARJORIE G. CUPP Provider 904-858-9740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2022-07-21 |