| NPI | 1669145561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IKISHIA NATAYE JACKSON Administrator/Owner 267-439-0966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA0600X Clinic/Center, Adult Day Care |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 385H00000X Respite Care | |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2021-07-27 |