| NPI | 1679813000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSE THELAMONT Provider 321-684-8722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: FL 6906251) |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2013-02-21 |