| NPI | 1750982047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANISHA T EDWARDS Owner 817-404-7733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 251S00000X |
| 310500000X Intermediate Care Facility, Mental Illness | |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| 364SL0600X Clinical Nurse Specialist, Long-Term Care | |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2023-12-31 |