| NPI | 1164055091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAHOULOME HAROLD GUIDI Owner/Provider 509-280-7164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2020-02-19 |