| NPI | 1124563697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCIA NGATIA Provider 774-262-3858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: WA 752761) |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2016-12-19 |