| NPI | 1679296099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE HENRY Owner/Director 888-422-7945 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2022-09-21 |