| NPI | 1790359784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MUGOMOKE Owner 469-910-4181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2021-05-14 |