| NPI | 1275184004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAQUISHA COKLEY Manager 262-332-8221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2020-04-02 |