| NPI | 1083469092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA SNOW JACOBS Administrator/Provider 678-600-6704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-08-04 |