| NPI | 1114399037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEAGAN NICOLE FRYE Administrator Licensee 269-783-4585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MI AM140370654) |
| Enumeration Date | 2015-10-30 |
| Last Update Date | 2015-10-30 |