| NPI | 1770165219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FILLE KINYAMAHANGA Co Owner 737-781-4755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-04-23 |
| Last Update Date | 2022-07-06 |