| NPI | 1891394722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELVIS BADNJEVIC Mgrm 813-505-4675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2020-10-21 |