| NPI | 1083356901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311Z00000X Custodial Care Facility |
| Additional Taxonomies | 305S00000X Point of Service |
| 310400000X Assisted Living Facility | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2022-04-11 |