| NPI | 1093419764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK S HAMMOND Owner 316-806-9242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2023-03-28 |