| NPI | 1992480768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT WATTS Owner 330-880-9167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2023-06-20 |