| NPI | 1235258658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA JEAN SMALL Adm Of Group Home 641-774-8252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2020-08-22 |