| NPI | 1710522495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYSON PAYNE Owner 606-872-1744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| Enumeration Date | 2019-11-17 |
| Last Update Date | 2019-11-17 |