| NPI | 1043614423 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 3104A0625X Assisted Living Facility Assisted Living, Mental Illness |
| 311Z00000X Custodial Care Facility | |
| 311ZA0620X Custodial Care Facility Adult Care Home | |
| 315P00000X Intermediate Care Facility, Mentally Retarded | |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2014-10-19 |