| NPI | 1164648572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM LUZE Program Director 712-944-4893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: IA S0074) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-22 |