| NPI | 1114614252 |
|---|---|
| Doing Business As | SUPPORTED LIVING HOME |
| Doing Business As | SUPPORTED LIVING AGENCY |
| Entity Type | Organization |
| Authorized Contact | BRENDA BAILEY Manager 360-802-9049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Enumeration Date | 2023-04-19 |
| Last Update Date | 2023-04-19 |