| NPI | 1063963304 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: MI 5202007360) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: TX 213858) |
| 314000000X Skilled Nursing Facility (Licence: CA OTA3577) | |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2016-10-21 |