| NPI | 1952852659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANDRIA CALLINS Owner 813-431-7064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: FL SA7606) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2016-10-18 |