| NPI | 1790252450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE PATE HENDERSON Owner 386-209-7649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 385H00000X Respite Care |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 347C00000X Private Vehicle | |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child | |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2020-09-04 |