| NPI | 1831895051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances | |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2023-12-01 |