| NPI | 1265064109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTA M TUPKER Designated Coordinator 320-983-5730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2020-02-09 |
| Last Update Date | 2020-02-09 |