| NPI | 1225757792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACIEANN JONES Executive Director 267-475-4090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2022-08-26 |