| NPI | 1235086372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY SIMMONS Administrator 262-239-3215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2026-03-16 |
| Last Update Date | 2026-03-16 |