| NPI | 1114277753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHEL S. GEORGE Pastor 972-966-9980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| 3104A0625X Assisted Living Facility Assisted Living, Mental Illness | |
| 311Z00000X Custodial Care Facility | |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2012-09-11 |