| NPI | 1699454793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND AGBOR Manager 712-221-5827 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2024-05-28 |