| NPI | 1043701634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MARK NELSON Co Owner 262-497-6294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: WI 15964) |
| Enumeration Date | 2018-05-20 |
| Last Update Date | 2018-05-20 |