| NPI | 1780831032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWEN HERMAN Owner 662-334-6335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 385H00000X Respite Care (Licence: MS 60609) |
| Additional Taxonomies | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child (Licence: MS 60609) |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child (Licence: MS 60609) | |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child (Licence: MS 60609) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2009-02-19 |