| NPI | 1700540523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRINA HAGINS Sole Proprietor 904-864-0890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3747A0650X Technician, Attendant Care Provider |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-10-27 |
| Last Update Date | 2022-02-15 |