| NPI | 1821786195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS D JACKSON CEO 813-347-2802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2023-04-25 |