| NPI | 1982345377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH MATOS Owner 706-945-5582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2022-04-07 |