| NPI | 1982289443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIQUITA JEFFERSON Owner/Administrator 229-588-1525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2021-03-16 |
| Last Update Date | 2022-02-02 |