| NPI | 1740007780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSELANDE H PETITHOMME Manager 239-989-4844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2024-09-23 |