| NPI | 1255607198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE M DAVIS Owner, Operator 360-718-8543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311Z00000X Custodial Care Facility (Licence: WA 751565) |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2012-03-26 |