| NPI | 1790181279 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: FL 472292425) |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2014-11-12 |