| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 3747P1801X Technician Personal Care Attendant |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| 323P00000X Psychiatric Residential Treatment Facility |
| 324500000X Substance Abuse Rehabilitation Facility |
| 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children |
| 343900000X Non-emergency Medical Transport (VAN) |
| 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| 320700000X Residential Treatment Facility, Physical Disabilities |
| 320800000X Community Based Residential Treatment Facility, Mental Illness |
| 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2025-03-01 |
| Last Update Date | 2025-03-03 |