| NPI | 1942887898 |
|---|---|
| Former Name | BETHANY JEAN CARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: CA 236417) |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2021-03-26 |