| NPI | 1073855813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY YANG Licensed Provider 651-373-7135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MN 1064668-1-AFC) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2013-03-20 |