| NPI | 1922753409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LILLIE TIDWELL Owner 863-595-6212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2022-02-14 |
| Last Update Date | 2023-07-13 |