| NPI | 1780643320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNER DUCHEINE CEO 772-340-7464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: FL 151076) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2020-08-22 |