| NPI | 1104784776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIE LARRY LEWIS Owner 489-674-6929 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances |
| Enumeration Date | 2026-01-13 |
| Last Update Date | 2026-01-13 |