| NPI | 1942834874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE DENISE HENDERSON CEO 972-822-8115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Mentally Retarded |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2020-03-01 |
| Last Update Date | 2023-01-27 |