| NPI | 1144856840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONELLY IKE Program Manager 281-818-0830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2020-03-14 |
| Last Update Date | 2020-12-31 |