| NPI | 1720698509 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH6339) |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility (Licence: AZ BH6339) |
| 347E00000X Transportation Broker | |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2021-03-09 |