| NPI | 1992454029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYELLE LATOYA ROLLINSON Managing Member 980-349-6489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| 253Z00000X In Home Supportive Care | |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances | |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2022-03-23 |