| NPI | 1700540481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN RACHEL GOINS Waiver Support Coordinator 239-362-5802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2021-10-28 |
| Last Update Date | 2021-10-28 |