| NPI | 1720625478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAQUEASHA TAMIKA HAYES Director 319-541-0973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2019-12-02 |