| NPI | 1700363140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS BROUGHTON Owner 251-593-8047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2018-08-07 |