| NPI | 1275293375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONDESA DELMAR CLARK Owner 262-505-4531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness |
| Enumeration Date | 2021-12-30 |
| Last Update Date | 2021-12-30 |