| NPI | 1811145006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE JOHNSON Provider 904-858-9740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2022-07-21 |