| NPI | 1699284844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE DENISE KING Owner 234-214-0379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2024-02-22 |