| NPI | 1811758402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALSHILOH S JOHNSON Personal Support Provider 773-990-9833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child |
| Additional Taxonomies | 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-01-19 |