| NPI | 1891396461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT MARTIN ROTH Owner 813-610-2982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2020-11-02 |
| Last Update Date | 2020-11-03 |