| NPI | 1760081228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANDY LEANNE FAULKNER Executive Director 469-845-6419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251B00000X Case Management |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| Enumeration Date | 2020-10-25 |
| Last Update Date | 2020-10-25 |