| NPI | 1912541129 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: AZ BH5909) |
| Additional Taxonomies | 251S00000X |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH5909) | |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2023-06-26 |