| NPI | 1851750558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERLY BASULTO Manager 305-546-0105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: FL 11-834-GH) |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2016-02-23 |