| NPI | 1154446367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD L JACOBS President 802-728-3802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home (Licence: VT 0109) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2020-08-22 |