| NPI | 1942152244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MODELEINE JEAN Administrator 239-878-3110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2026-02-10 |
| Last Update Date | 2026-02-10 |