| NPI | 1750119939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRASHONDA R DEWALT Staff End User/ Program Provider 832-579-4545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2024-08-11 |