| NPI | 1063172674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIDIER RUNEZERWA Owner 207-518-1102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 3747A0650X Technician Attendant Care Provider |
| Enumeration Date | 2021-12-22 |
| Last Update Date | 2023-11-07 |