| NPI | 1720575251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIE NOVELO TANDIONO-CELLONA Owner 702-882-4975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251C00000X |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2019-06-13 |