| NPI | 1144117573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAQUITTA DAMPEER Administrator/ Sole 262-291-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 311Z00000X Custodial Care Facility |
| 385H00000X Respite Care | |
| Enumeration Date | 2025-06-19 |
| Last Update Date | 2025-06-19 |