| NPI | 1245387299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY PETER Administrator 712-792-3785 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: IA 001) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2022-07-21 |