| NPI | 1194017194 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: WI 155143-030) |
| Additional Taxonomies | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: WI 155143-030) |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2011-06-12 |