| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251E00000X Home Health |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 320700000X Residential Treatment Facility, Physical Disabilities |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| 374U00000X Home Health Aide |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2022-07-21 |