| NPI | 1093194383 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DETRA THOMAS Owner 469-328-1042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 310400000X Assisted Living Facility | |
| 311ZA0620X Custodial Care Facility Adult Care Home | |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2015-05-20 |