| NPI | 1730507989 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| 373H00000X Day Training/Habilitation Specialist | |
| 385H00000X Respite Care | |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2021-03-15 |