| NPI | 1003065707 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 171W00000X Contractor (Licence: TX 001000618) |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2018-08-08 |