| NPI | 1164780540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNETTA MATRICE NICHOLS Owner 281-409-4862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2012-04-24 |