| NPI | 1073150074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY JAMES BOYSUN Ppo 541-269-7955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 374U00000X Home Health Aide |
| 376K00000X Nurse's Aide | |
| 385H00000X Respite Care | |
| 405300000X Prevention Professional | |
| Enumeration Date | 2019-12-09 |
| Last Update Date | 2019-12-09 |