| NPI | 1801007612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHEL REYES Owner 813-476-3102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: FL LIC. MA44756) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |