| NPI | 1659249837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH HART Owner 325-665-6736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2025-10-28 |
| Last Update Date | 2025-10-28 |