Organization
TRADITIONAL COMMUNITY LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY G JOHNSON (OWNER)
(302) 424-0907
Entity
Organization
Contact information
Practice address
8367 BRICK GRANARY ROAD, LINCOLN, DE 19960
(302) 424-0907
Mailing address
8367 BRICK GRANARY RD, LINCOLN, DE 19960-3812
(302) 424-0907
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
20120227152
DE
Other
Enumeration date
03/29/2012
Last updated
03/29/2012
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