| NPI | 1780198432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE COBBS Owner 321-438-3744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2017-11-16 |
| Last Update Date | 2017-11-16 |