| NPI | 1932749850 |
|---|---|
| Doing Business As | 103 E VISER ST |
| Entity Type | Organization |
| Authorized Contact | BRANDI TURNER Licensing Coordinator 682-707-2756 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2025-03-13 |