| NPI | 1750130563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH MEARIE JACKSON Owner 571-285-9186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 251E00000X Home Health |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| Enumeration Date | 2024-05-14 |
| Last Update Date | 2025-08-25 |