| NPI | 1023727500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLYANN SUE Managing Member 347-258-0686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2022-11-23 |
| Last Update Date | 2022-11-23 |