| NPI | 1770857583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANTE LYNETTE DOBBINS Owner 209-769-4541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: CA 247204068) |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2012-02-27 |