| NPI | 1881051852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETRAND C EZEMA EZEMA Owner 512-579-9698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: TX 650576540002) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: TX 650576540002) |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: TX 650576540002) | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: TX 650576540002) | |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2016-01-21 |