| NPI | 1093220162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY E COLOMBO Provider 520-788-3041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: AZ BH5355) |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2017-12-11 |